Diabetes Research Initiatives in Sharjah, UAE

Nabil Sulaiman
nsulaiman@sharjah.ac.ae n.sulaiman@unimelb.edu.au
Diabetes Supercourse, Alexandria 12 Jan 2009

Sharjah Diabetes Study

Background Why the study

Methods
Preliminary results Conclusions Recommendations

Environmental and behavioral changes

New dietary habits (what and how we eat), Lack of physical activity, Overweight/ obesity, and Stresses of urbanization and working condition
will lead to further rise of CVD and diabetes, and their risk factors.

Summary
Diabetes is a major and complex health problem worldwide. Prevalence in UAE (24% & IGT18%) is the 2nd highest in the world Onset of the disease in the GCC is early in late 20s With early Dx and appropriate Mgt diabetics can live better and longer

Sharjah Diabetes Study

N. Sulaiman, Dh. Al Badri, N. Sajwani, S. Saleh, D. Young

1 Nabil

Sulaiman, 2Dhafir Al Badry, 2Najla Sajwany, 1Amal Hussein, 1Saba Saleh, 2Doris Young
2 Ministry

(1Department of Family and Community Medicine, University of Sharjah,

of Health UAE, 3Department of General Practice, University of Melbourne)

METHODOLOGY

Background
Diabetes is a major and complex health problem worldwide. Diabetes prevalence in UAE is the 2nd highest in the world, reaching about 24% in UAE nationals. The prevalence of pre diabetes is reported to be about 18%. With early identification and appropriate management, people with diabetes can live better and longer

PRELIMINARY RESULTS The study design is a cross sectional baseline survey of patients with diabetes attending Primary Medical Care Centers in Sharjah during 2007/08. Participants: 347 diabetic patients were interviewed and their medical records were cheeked Gender: 65.4% (n= 227) females and 34.6% (n=120) males Nationality: UAE 83.9%, Pakistan 3.5%, Egypt 2.6%, others 10% including Palestine, Lebanon, Yemen, Iraq, Poland , Syria, Iran and Sudan. 1. 2. 3. 4. 5. Data Collection Research Assistant attended diabetes mini clinics at Riffa and Asit centres and diabetes clinic at Al-Qassimi and Kuwaiti Hospitals: Patients were invited to participate Patients were interviewed using structured questionnaires Their data were extracted from medical records Data cleaning and analysis was performed using SPSS Marital Status: 8.9% single, 87.9% married, divorced 1.4% and 1.4% widowed. Consanguineous Marriage: 16.4% (n=57) Occupation: : 47.3% housewife, 28.2% clerks, 6.3% students, 0.6%retired. Family History: 23.1% (N=80) had a positive family history of diabetes. Smoking: 3.2% (n=11) current smokers, 3.2% (n=11), ex-smokers, never smoked 93.1% (n=323).
Diabetes Duration (mean) Males (N=120) 7.1 4.9 30.9 6.0 9.9 4.3 26.4% Females (N=227) 8.5 7.4 27.8 5.3 9.4 3.7 31.4%

Aim
To improve diabetes management, control and quality of life of patients with diabetes in UAE

Objectives
1. Establish an electronic database for diabetic patients in Sharjah Diabetes Control Indicators 2. Audit their medical records to identify gaps in management. 3. Pilot test known EB intervention to investigate their appropriateness to Sharjah 4. Determine barriers and facilitators to the implementation of the intervention
Diabetes in family
200
250

BMI (kg/m*m) Fasting B Sugar (mmol/l) Diabetes complications%

body weight and waist circumference from medical records knowledge and attitudes towards healthy eating using physical activity questionnaire and Biochemical indicators such as AbA1c and cholesterol, lipids, blood glucose and urine test

Current Diabetes management method

Current Diabetes management method

200

150

150

100

50

None Diet only Tablets only Insulin only 100 Diet & Tablets Diet & Insulin Diet, tablets & Insulin Unknown Others 50 Missing

Frequency

0 Yes No Not sure

Frequency

0 None Diet only Tablets only Insulin only Diet & Tablets Diet & Insulin Diet, tablets & Insulin Unknown Others

Diabetes in family

Current Diabetes management method

Self monitoring

CONCLUSIONS
250

1. Diabetes Mellitus is common problem in primary medical centers in Sharjah.

200

2. There is gap in self-management education including self monitoring, manifested by high levels of obesity and lack of physical activity. 3. Diabetes control in Sharjah measured by HbA1c could be improved compared with international guidelines. 4. Measures to improve control may include employing Diabetes Nurse Educators to assist doctors at the medical centers to train patients as well as CME courses for doctors working at the centers.
Yes No

Frequency

150

100

50

Self monitoring

This project was funded by the University of Sharjah. For information please contact Dr Nabil Sulaiman, HOD Family and Community Medicine, The University of Sharjah E-mail: nsulaiman@sharjah.ac.ae or n.sulaiman@unimelb.edu.au

Sharjah Diabetes Study

Aim To improve diabetes management, control and quality of life of patients with diabetes in UAE

Sharjah Diabetes Study

Objectives Identify gaps in diabetes management Determine barriers and facilitators to implementation of known interventions Pilot test known EB intervention in Sharjah

Study Design
Cross sectional baseline survey of patients with diabetes attending Primary Medical Centers in Sharjah during 2007/08.

Data Collection
Research Assistant attended diabetes mini clinics at Riffa and Wasit centres and diabetes clinic at Al-Qassimi and Kuwaiti Hospitals: Patients were invited to participate and interviewed using questionnaires Their data were extracted from medical records Data cleaning and analysis was performed using SPSS

Diabetes Control Indicators

Medical Records: Biochemical indicators such as HbA1c and cholesterol, lipids, blood glucose and urine test Weight and waist circumference Patients questionnaire: Knowledge and attitudes

healthy eating physical activity

Preliminary Results
Sample: 347 patients Gender: 65.4% females Mean age 53.2 (14.6) BMI 29.8 (5.9)

Nationality
UAE 83.9%, Pakistan 3.5%, Egypt 2.6%, Others: 10% (Palestine, Lebanon, Yemen, Iraq, Syria, Iran and Sudan)

Diabetes in Families
Diabetes in family

250

200

Frequency

150

100

50

0 Yes No Not sure

Diabetes in family

Marital Status
Marital Status
87.9% married 8.9% single 2.8 divorced/widowed

Consanguineous Marriage: 16.4% (n=57)

Gender difference
Diabetes Duration (mean) BMI (kg/m*m) Fasting B Sugar (mmol/l) Diabetes complications% Males (N=120) 7.1 4.9 30.9 6.0 9.9 4.3 26.4% Females (N=227) 8.5 7.4 27.8 5.3 9.4 3.7 31.4%

HbA1c: 78% of patients has HbA1c (>7%) BP: 57% have high BP

Management Methods
Current Diabetes management method
200

150

Frequency

100

50

0 None Diet only Tablets only Insulin only Diet & Tablets Diet & Insulin Diet, tablets & Insulin Unknown Others

Current Diabetes management method

Complications (83)
26 (Eye glaucoma, laser surgery) 74 (feet ulcer, loss of sensation) 2 (Kidney: protein urea or albumin urea) 4 (loss of toe/ foot) 6 (angina, heart attack)

Self monitoring
Self monitoring

250

200

Frequency

150

100

50

0 Yes No

Self monitoring

Self Management
I can exercise several times a week (25% strongly agree) I can not exercise unless I feel like exercising (28% strongly agree) I can recognize when my blood sugar is too high (27% strongly agree)

Self Management
I can do what was recommended to prevent low blood sugar (24% SA) I can figure out what self treatment when blood sugar gets high (29% SA) I can fit my diabetes self treatment routine into my usual lifestyle (26% SA)

CONCLUSIONS
Diabetes Mellitus is common problem in primary medical centers in Sharjah. High levels of obesity Low physical activity Gap in self-management education including self monitoring, manifested by high levels of obesity and lack of physical activity.

Recommendations
Diabetes management in Sharjah could be improved compared with international guidelines Measures to improve control:

Diabetes Nurse Educators Patients self management education Peer-led or peer-support models CME for doctors at PHC centers

Thank You